This paper empirically examines the influence of health insurance on health care utilization in Uasin Gishu County, Kenya. The study adopted an explanatory research design and employed a quantitative cross-sectional household survey. Data were collected using structured questionnaires from residents sampled proportionally across the county’s six constituencies. Hypotheses were tested using binary logistic regression, and average marginal effects were estimated to translate coefficients into absolute probability differences. With utilization coded as any use in the recall period, insurance showed a statistically significant negative association with care-seeking, indicating that nominal coverage did not translate into higher realized use in this setting. Taken together, the findings point to implementation frictions, benefit awareness gaps, residual point-of-service charges, and supply-side constraints as plausible mechanisms that blunt insurance’s expected enabling effect. County health managers should therefore clarify entitlements and eliminate informal fees; assure availability of essential medicines and basic diagnostics at first contact; realign empanelment and contracting to where clients actually seek care; and expand time-compatible access through after-hours/weekend clinics, express lanes, workplace/mobile outreaches, and appointment systems. Embedding assisted enrollment/renewal and monitoring insured visits by sector can further convert coverage into first contact.
Leonard et al. (Wed,) studied this question.